Red Light-Green Light on Health-Care Reform

WASHINGTON
— AMERICANS often fail to see a link between their daily lives and what's happening in Washington.

But if Congress passes, and President Clinton signs, a plan to make health insurance portable between jobs, millions of Americans should take notice.

Between 21 million and 25 million people would benefit, says the General Accounting Office. People with preexisting health conditions would no longer have to worry that a job change might mean going without health insurance. Employees who leave salaried positions - and the benefit of group health-insurance coverage - would find it easier to buy individual health insurance that meets their needs.

The Senate has already settled on a basic plan that has strong bipartisan support, and a promised signature from Mr. Clinton.

House version at issue

The situation in the House is more complicated. Several competing plans - some strongly opposed by Democrats - are up for consideration today in the Rules Committee. House Speaker Newt Gingrich of Georgia, who plays a crucial role in guiding the committee, appears ready to allow his chamber to pass a bill the Senate and Clinton would reject, say Senate Democratic aides and other observers.

The full House of Representatives will vote Thursday on its health insurance plan. ''I think they'll load it up and pass it,'' says Ed Howard, vice president of the nonpartisan Alliance for Health Reform, which supports universal health-care coverage.

By ''loading it up,'' Mr. Howard is referring to various provisions that some House members want to add to the basic plan. One would limit damages awarded in medical-malpractice suits, a provision Democrats oppose. Another would allow people to set up medical-savings accounts that work like individual retirement accounts, an idea that critics charge would help mainly the healthy and wealthy.

The question for Mr. Gingrich and Senate majority leader Bob Dole (R) of Kansas is whether they want to steer the bill toward a presidential signature or not.

Enter election-year politics. If the legislation is implemented - marking the first piece of national health reform, however modest, in four years - Clinton would get a boost. But so would Senator Dole, Clinton's main rival for the White House, and the Republican-controlled Congress.

Ironically, it's election-year politics that has brought the issue of insurance portability back to life in the first place. Faced with the prospect of running for reelection on a lean record of accomplishment, the 104th Congress needed something to take to the voters that would resonate. Health-insurance reform fits the bill.

The more-modest Senate version won an endorsement last week from the association of independent insurance agents, which had opposed the major health reform Clinton tried to enact during the first two years of his term. All that remains for the Senate bill, whose lead sponsors are Sens. Nancy Kassebaum (R) of Kansas and Edward Kennedy (D) of Massachusetts, is a strong signal from Dole.

Missing: Dole support

In the past, Dole has supported health-care reform that addresses portability and preexisting conditions. In September 1994, he told a pharmaceutical group that legislators ''ought to be whacked'' if they don't pass a scaled-down version of health-care reform in 1995.

But now, with his presidential ambitions on the line, he's playing it cautious. He has yet to sign on as a cosponsor of the Kennedy-Kassebaum bill. He has, at least, scheduled the bill for Senate floor debate and a vote April 18 and 19.

At play is the new dynamic between Dole and Gingrich. The voluble House Speaker has agreed to play ''junior partner'' to his Senate counterpart in an effort to help his party win the White House. But it remains to be seen if Gingrich can make the more conservative House Republicans play along.

One scenario, says a Senate Democratic aide, would have Gingrich allow his troops to pass a ''loaded down'' bill that puts members on the record as supporting provisions like the medical savings accounts. Then, in a House-Senate conference, a version acceptable to the Senate and to Clinton could emerge.

The lingering question: Can Dole engineer such an outcome? It's in his own interests, say Democrats. ''It would be a help to him politically if he pushed this through,'' says the Senate aide.